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1 free Paramedic practice questions: Seizures

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Question 1 of 1

A 34-year-old patient is having a generalized seizure that has continued for 4 minutes in a restaurant. The teeth are tightly clenched and the lips are cyanotic. High-concentration oxygen is being delivered by mask, and the head has been padded to prevent injury. The vital signs are P 132, R 26 and irregular, and SpO₂ 88%. Which airway adjunct is most appropriate for this patient?

Show the answer and rationale

Correct answer · Nasopharyngeal airway

This patient is seizing with a clenched jaw and a blocked airway. A nasopharyngeal airway (NPA) is the right adjunct. The teeth are tightly clenched, the lips are cyanotic, and the SpO₂ is 88%. During the tonic phase of a generalized seizure, the jaw muscles, the masseter and temporalis, lock in a constant contraction and seal the mouth shut. The tongue and soft palate can still fall back against the back of the throat and block the airway. The blocked airway is causing the cyanosis and the low SpO₂. The NPA goes in through the nostril and follows the floor of the nose to the throat. The NPA gets around the clenched jaw completely. Place the NPA so oxygen can keep getting in now, instead of waiting for the seizure to end.

Why the others are wrong

Oropharyngeal airway: An oropharyngeal airway (OPA) is the standard first airway for an unconscious patient whose tongue is blocking the airway. The OPA goes in through an open mouth and is sized from the earlobe to the corner of the mouth. This patient's teeth are clenched shut, so an OPA cannot be placed. An OPA becomes an option once the seizure ends and the jaw relaxes.

Bite block between the teeth: Some teach putting an object between the teeth to protect against tongue biting. Current guidance rejects this practice. The teeth are tightly clenched and actively contracting. Prying anything between them can knock teeth out, cut the mouth, or break the device and leave a foreign body in the airway. Padding around the patient is the right precaution, not forcing the mouth open.

Supraglottic airway device: A supraglottic airway is placed through the mouth in an unresponsive patient with no gag reflex. This patient is actively seizing with the teeth clenched, so nothing can go in through the mouth. Consider a supraglottic airway only after the seizure, if breathing is still inadequate.

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